Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludağ University, Bursa, Turkey.
Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Rheumatology (Oxford). 2023 Dec 1;62(12):3962-3967. doi: 10.1093/rheumatology/kead318.
The objectives of this study were to assess the clinical characteristics, predictive factors, and practical algorithms of paradoxical reactions (PRs), specifically paradoxical psoriasis (PP).
The TReasure database is a web-based prospective observational cohort comprised of patients with RA and SpA from 17 centres around Turkey since 2017. A cohort study and a case-control study nestled within the cohort were identified.
In total, 2867 RA and 5316 SpA patients were evaluated. The first biologic agent was found to have caused PRs in 60% of the 136 patients (1.66%) who developed the PRs. The median time interval between the PRs and biological onset was 12 months (range 1-132 months, mean 21 months). The most common types of PP, constituting 92.6% of PRs, were pustular (60.3%) and palmoplantar (30.9%). Adalimumab (30.9%), infliximab (19%) and etanercept (17.4%) were the most common agents causing the PP. In the treatment of most PP patients (73.2%), switching biologic agents was favoured, with TNF inhibitor (TNFi) chosen in 46.03% and non-TNFi in 26.9% of cases. The three most frequently selected drugs were etanercept (24.6%), secukinumab (9.5%) and adalimumab (8.7%). Only 5.17% of patients who switched to another TNFi showed progression. The odds ratios (s) for SSZ, HCQ, and LEF use were significantly higher in RA controls than in PP patients (P = 0.033, OR = 0.15; P = 0.012, OR = 0.15; and P = 0.015, OR = 0.13, respectively). In the PP group with SpA, the number of smokers was significantly higher (P = 0.003, OR: 2.0, 95% CI: 1.05, 3.81).
Contrary to expectations based on earlier research suggesting that paradoxical reactions develop with the class effect of biological agents, the response of patients who were shifted to another TNFi was favourable.
本研究旨在评估矛盾反应（PRs），特别是矛盾性银屑病（PP）的临床特征、预测因素和实用算法。
TReasure 数据库是一个基于网络的前瞻性观察队列，由自 2017 年以来来自土耳其 17 个中心的 RA 和 SpA 患者组成。在该队列中确定了一项队列研究和一项病例对照研究。
共评估了 2867 例 RA 和 5316 例 SpA 患者。在出现 PR 的 136 例（1.66%）患者中，发现首例生物制剂导致了 60%的 PRs。PR 与生物起始之间的中位时间间隔为 12 个月（范围 1-132 个月，平均 21 个月）。最常见的 PR 类型为脓疱性（60.3%）和掌跖脓疱性（30.9%），占 PR 的 92.6%。导致 PP 的最常见药物分别为阿达木单抗（30.9%）、英夫利昔单抗（19%）和依那西普（17.4%）。在大多数 PP 患者（73.2%）的治疗中，首选切换生物制剂，其中 46.03%选择 TNF 抑制剂（TNFi），26.9%选择非-TNFi。选择频率最高的三种药物分别为依那西普（24.6%）、司库奇尤单抗（9.5%）和阿达木单抗（8.7%）。仅 5.17%转换为另一种 TNFi 的患者出现进展。SSZ、HCQ 和 LEF 使用率在 RA 对照组中明显高于 PP 患者（P=0.033，OR=0.15；P=0.012，OR=0.15；P=0.015，OR=0.13）。在伴有 SpA 的 PP 组中，吸烟者的数量明显更高（P=0.003，OR：2.0，95%CI：1.05，3.81）。
与早期研究提出的生物制剂类效应导致矛盾反应的预期相反，转换为另一种 TNFi 的患者的反应是有利的。
